Can injuries from falls due to a connected back condition be considered secondary?

[Shelly.]

Hello, new here and not sure if I'm posting this in the correct forum... 

My husband (who gave me permission to post this) is currently rated at 20% for Degenerative Arthritis of the Spine. Since that initial rating several years ago his condition has gotten a lot worse and will be going in for an increase with additional diagnosed disabilities that have not yet been connected. I have a question though, due to his worsening condition (pretty bad drop foot in his right leg and drop foot in left leg) he has fallen several times even though he wears leg braces. Can his shoulder, knee and elbow conditions be linked as service connection because of them being injured from his falls if we cant link them to service? We do have several pictures of pretty severe brusing and scrapes / skin tears on his elbow, legs, and face from his falls. Below is information that we have gathered from a portion of his VA medical records. 

Current Rated Disabilities
•    Degenerative Arthritis of the Spine (20%)
•    Tinnitus (10%)
•    Scars (0%)
•    Impaired Hearing (0%)

Non-Rated Diagnosis (noted in VA medical records)
•    Foot drop – left & right foot “due to acute disc condition” 
•    Severe obstructive sleep apnea 
•    Posterior horn medial meniscal tear, left knee
•    Medial epicondylitis, left elbow 
•    Bone spurs, neck & heels 
•    Plantar fasciitis 
•    Other intervertebral disc degeneration, lumbar
•    Ulnar neuropathy 
•    Unspecified abnormalities of gait and mobility
•    Insomnia disorder
•    Depression 
•    PTSD 
•    Cervical radiculopathy
•    Multilevel disc herniations “likely causing some radicular symptoms”
•    Radiculopathy & thenar atrophy, left hand 
•    Spinal stenosis / foraminal stenosis C4-C5 & C6-C7
•    Atrophy of the 1st dorsal / palmar interossei and thumb adductor 
•    Hiatal hernia  
•    GERD 
•    Rotator cuff tear / rupture
•    Prostate cancer
•    Erectile disfunction

Surgeries
•    Three lower back surgeries
•    Two shoulder surgeries, left & right (complete rotator cuff tear or rupture of right shoulder, not specified as traumatic) “Progression of pain and chronicity of symptoms is consistent by his history with his injury in 1996”
•    Ulnar nerve surgery, elbow
•    Knee surgery (left) posterior horn medial meniscal tear – “Progression of pain and chronicity of symptoms is consistent by his history with his injury in 1996”
•    Esophageal dilation – Hiatal hernia

Medical Equipment Prescribed 
•    Prosthetic leg braces
•    Cane
•    Walker
•    Crutches
•    Toilet riser
•    Shower chair
•    CPAP machine
•    Tens Unit 
•    V pulse
•    Knee brace (left)
•    Wrist braces (left & right)
•    Arm sling
•    Hearing aids
•    Shoe insoles
•    Sleep machine

Medications
•    Gabapentin – 600mg - one tablet 3 times a day for mood / nerve pain / insomnia
•    Buspirone HCL – 10mg - two tablets 3 times a day for anxiety & irritability
•    Bupropion HCL – 150mg - two tablets every morning for mood / motivation energy
•    Duloxetine HCL – 60mg - one capsule twice a day for mood & anxiety
•    Mirtazapine – 15mg - one tablet at bedtime for sleep / nightmares
•    Clonidine HCL - 0.2mg - one tablet at bedtime for sleep / anxiety / nightmares
•    Lisinopril – 10mg - one tablet at bedtime for blood pressure
•    Pantoprazole NA – 40mg - one tablet before breakfast for hiatal hernia  
•    Atorvastatin Calcium – 20mg - ½ tablet at bedtime 
•    Megestrol Acetate 20mg - one tablet daily to help with side effects of prostate cancer treatment
•    Abiraterone Acetate (Zitega) – 250mg - four tablets daily for prostate cancer hormone therapy
•    Prednisone – 10mg - ½ tablet twice a day to support Abiraterone
•    Iron - 65MG - one tablet a day for anemia 
•    Calcium - 500MG - one tablet a day
•    Vitamin B-12 - 1000mgc - one tablet per day
•    Lidocaine cream
•    Naproxen
•    Bilateral shoulder injections
 

[Vync]

Welcome to Hadit! 

Possibly...

Regarding worsening, check out the rating criteria first at https://www.law.cornell.edu/cfr/text/38/4.71a. There are a number of ways to increase a back rating based on worsening.

I know from personal experience with back issues that falls can happen, especially if balance becomes compromised like during a spasm or acute pain. If he had an episode and fell and broke his arm, that injury might be able to be connected as secondary.

Also consider secondary issues from a couple of approaches. The military and the VA loved giving motrin or naproxen for pain reduction. That and other NSAID meds can do a number on the digestive tract (i.e. side effects of meds used to treat a connected disability) which can lead to heartburn or GERD which the VA classifies as hiatal hernia. Even after surgery, it can come back if NSAID meds are in use. Also, long term NSAID use is not good for the heart and other other organs.

Think of that old song "the hipbone is connected to the thighbone" in terms where a musculoskeletal issue can impact his walk and also nerves. A cane can change his gait. Flare ups can result in nerve pain like sciatica into the leg nerves. The VA treats the cervical spine  (neck) as one segment and the rest as a separate segment that can be connected. What goes up may also come down in terms of impact. It is not unusual for vets who have lumbar issues to develop issues with other joints, even in to the neck, shoulders, knees, etc... It could also cause headaches, too.

Also consider his mental health. It definitely stinks that a vet feels like they are falling apart, losing independence, and might have to avoid enjoyable activities to avoid pain. Depression is common. The VA or another mental health provider might prescribe antidepressant meds to help the vet cope. Those kind of meds can have a negative effect during intimacy, too...

This is not exhaustive, but I hope it provides some level of benefit. Good luck!

[Tbird]

•  This is granted if a service-connected disability aggravates a non-service-connected disability worse. The more common type of secondary service connection is where a service-connected disability causes another disability.   An example of this would be a case of a veteran’s diabetes causing his/her peripheral neuropathy. Another example would be a veteran’s service-connected back ailment or injury causing radiculopathy or the same back ailment or injury leading to knee problems.

Note:  Secondary Service Connection and Presumptives are a little easier.  If you have a diagnosis, and a doctor says that your diagnosis is at least as likely as not due to your (service-connected condition), then you need not AGAIN establish an in-service event or aggravation.    A presumptive Service connection means if you meet the applicable criteria, your condition is “presumed” to be caused by military service.  You will still need a current diagnosis, but you may get a bye on the nexus if you meet the requisite criteria for presumptive conditions. Caluza Triangle defines what is necessary for service connection

References

• 38 CFR 4.71 4.71a Schedule of ratings—musculoskeletal system
• 38 CFR 3.310 Disabilities that are proximately due to, or aggravated by, service-connected disease or injury

These cases may be helpful:

 

• 1828480.txt veteran uses a cane and reported falls secondary to back pain

• 1226605.txt his back pain. Due to prior falls secondary to back pain, the Veteran reported

• 1124285.txt orthosis, but reported several falls secondary to back pain, the last being one year

• 0815650.txt back pain, back spasms, or falling secondary to back problems

• 0621935.txt back pain, back spasms, or falling secondary to back problems

 

I hope this is useful.

[broncovet]

Correct.  You need a doctors opinion that your (secondary condition) is at least as likely as not due to your (primary service connected condition, that is the other condition which caused it).  

[Rattler]

To quote brocovet as he is the one who probably gets tired of posting the same thing. (Thanks broncovet for all your hard work.)

1. You need an in-service event.

2. A current diagnosis. (It looks like you have that.)

3. And a Nexis. (A doctor or nurse practitioner who says they are connected.)

You Stated;

Non-Rated Diagnosis (noted in VA medical records)
•    Foot drop – left & right foot “due to acute disc condition” 
•    Severe obstructive sleep apnea 
•    Posterior horn medial meniscal tear, left knee
•    Medial epicondylitis, left elbow 
•    Bone spurs, neck & heels 
•    Plantar fasciitis 
•    Other intervertebral disc degeneration, lumbar
•    Ulnar neuropathy 
•    Unspecified abnormalities of gait and mobility
•    Insomnia disorder
•    Depression 
•    PTSD 
•    Cervical radiculopathy
•    Multilevel disc herniations “likely causing some radicular symptoms”
•    Radiculopathy & thenar atrophy, left hand 
•    Spinal stenosis / foraminal stenosis C4-C5 & C6-C7
•    Atrophy of the 1st dorsal / palmar interossei and thumb adductor 
•    Hiatal hernia  
•    GERD 
•    Rotator cuff tear / rupture
•    Prostate cancer
•    Erectile disfunction

Have you applied for any of these? And why not?

The VA will not rate you if you don't apply.

 

 

[relatively happy camper]

If it were me, I would pursue the secondary claim.  I'd also pursue a number of other claims that they have rated as NSC.  jmo

[Rattler]

I would say its a good chance of secondary for meds affect too.